Healthcare Benefits for Employees

At Taylor Benefits Insurance, we believe in supporting organizations that want to offer the best possible healthcare benefits for employees. Whether you are providing medical employee benefits for the first time or expanding an existing plan, understanding the available options can make a significant difference for both your staff and your bottom line. Below, we outline the fundamentals of providing staff medical benefits in the U.S., from required programs to voluntary offerings.

What Are Employee Health Benefits?

Employee health benefits (often referred to as company medical benefits, health staff benefits, or simply healthcare benefits for employees) are services designed to help employees maintain their overall well-being and address any health-related issues. These typically come as part of a salary package or employment contract. While no universal federal law requires all employers to provide company health benefits, many organizations do so to attract talented employees, retain their current workforce, and promote a healthier, more productive team.

Are You Required to Provide Health Benefits to Employees?

Affordable Care Act (ACA)

Under U.S. federal law, if you employ 50 or more full-time and full-time equivalent (FTE) staff, the Affordable Care Act (ACA) requires that you offer medical employee benefits meeting specific standards of coverage and affordability. This usually includes coverage for the employee and their dependents, such as children up to age 26.

• Minimum Coverage Requirement: Plans must meet essential health benefits and cost thresholds to be considered affordable.
• Penalties: Failing to comply with ACA regulations can lead to fines, so it’s crucial to stay informed.

State and Local Regulations

Certain state or local laws may mandate additional provisions for staff medical benefits, including disability insurance or expanded coverage options. We recommend working with an HR professional or a benefits specialist who understands compliance requirements for US employee health in your specific region.

Benefits Required by Law

Even organizations that do not meet ACA thresholds must provide some mandatory benefits:

• Workers’ Compensation: Covers medical costs and lost wages if an employee is injured or becomes ill due to work.
• Social Security and Medicare Contributions: Both employees and employers contribute to these federal programs.
• Unemployment Insurance: Provides financial support to qualified employees who lose their jobs.
• Family and Medical Leave Act (FMLA): For companies with more than 50 employees, this law grants up to 12 weeks of unpaid leave for family or medical needs.

Depending on the state, additional disability coverage may also be mandated.

Types of Employee Health Benefits

When we help organizations develop healthcare benefits for employees, we often discuss a range of coverage options. Some common company health benefits include:

1. Medical Insurance: Covers hospital stays, doctor visits, and preventive care. Plans vary by premium, deductible, and in-network providers.
2. Dental Insurance: Dental insurance cover helps pay for routine cleanings, fillings, and more extensive procedures.
3. Vision Insurance: Offsets costs for routine eye exams, glasses, or contact lenses.
4. Mental Health and Employee Assistance Programs (EAPs): Offers counseling, therapy, and stress management resources.
5. Disability Insurance (Short and Long Term): Protects income if an employee cannot work due to a disability.
6. Life Insurance: Provides a death benefit to an employee’s designated beneficiary.
7. FSA, HSA, or HRA Accounts: Pre-tax or employer-funded accounts used for qualified healthcare expenses.
8. Wellness Programs: Encourages healthy lifestyles through gym memberships or wellness coaching.
9. Paid Sick Leave: Offers financial protection during short-term illnesses.

Employer Contributions to Health Staff Benefits

Organizations often contribute toward the cost of premiums, deductibles, or co-payments for their staff medical benefits. Some employers also add funds to employee healthcare spending accounts (FSAs, HSAs, HRAs) to alleviate out-of-pocket expenses.

Providing comprehensive company medical benefits can give you a significant edge in retaining loyal, productive employees. Workers often prioritize health staff benefits when deciding on a job offer, which can help you stand out against competitors.

Health Plans to Consider

When designing healthcare benefits for employees, you will encounter several types of group health insurance plans:

1. Health Maintenance Organization (HMO): Typically covers only in-network doctors and hospitals, except in emergencies.
2. Preferred Provider Organization (PPO): Offers flexibility to see out-of-network providers, though at a higher cost.
3. Point of Service (POS): Similar to a PPO but requires a referral from a primary care provider to see a specialist.
4. Exclusive Provider Organization (EPO): Covers only in-network care, with limited exceptions.

Plan Categories

Plans are often labeled bronze, silver, gold, or platinum. Generally:

• Bronze: Lower monthly premiums but higher out-of-pocket costs.
• Platinum: Higher premiums but lower out-of-pocket costs.

It’s also wise to look at the plan’s quality ratings, which evaluate member experience, medical care, and plan administration.

Rules Around Health Care Plans

We recommend adhering to regulations that govern eligibility, enrollment periods, and plan affordability. Consider the following:

• COBRA: The COBRA loophole 60 days allow certain employees to remain on your organization’s health plan after employment ends for 2 months.
• Affordability Requirements: Monthly premiums for medical employee benefits must fall below a certain percentage of an employee’s income to be compliant with ACA standards.

We suggest partnering with a benefits specialist or HR professional to navigate these rules effectively and ensure you provide compliant US employee health coverage.

Advantages of Offering Company Health Benefits

1. Improved Employee Well-being

Comprehensive healthcare benefits for employees encourage preventive care and regular check-ups. This can help catch potential issues early, reduce absenteeism, and enhance overall morale.

2. Increased Productivity

When employees can address health concerns quickly, they can return to work sooner or manage chronic issues more effectively. This reduces the risk of workplace interruptions or the spread of contagious illnesses.

3. Attracting and Retaining Talent

A robust company medical benefits package can be the deciding factor when top talent is comparing job offers. Providing essential health staff benefits shows you value your workforce, which can boost both recruitment and retention.

4. Tax Advantages for Employers

Many costs associated with staff medical benefits are tax-deductible, such as premiums and contributions to healthcare spending accounts. Small businesses meeting specific criteria may also qualify for tax credits.

5. Higher Employee Satisfaction

When employees see that you prioritize their well-being through quality company health benefits, they tend to feel more loyal and engaged. This sense of security and support fosters a positive workplace culture and can reduce turnover.

Develop a Benefits Program with Taylor Benefits

We understand that designing or updating company health benefits can feel complex. Our team at Taylor Benefits Insurance has years of experience guiding employers toward solutions that align with both legal requirements and organizational goals. We focus on education and guidance, ensuring you can confidently select the healthcare benefits for employees that fit your budget and meet your staff’s needs.

If you’d like to discuss medical employee benefits that align with your unique business objectives, we’re here to help. Our benefits specialists take into account compliance regulations, plan structures, and cost-effective strategies so you can invest in the long-term success and well-being of your team. Feel free to reach out for more information on how we can support your efforts in providing the best possible US employee health coverage.